Via practica 1/2017
Betamethasone in the treatment of painful musculoskeletal disorders – indications, efficacy and safety profile
Betamethasone is a synthetic glucocorticoid with several intensive therapeutic effects – anti-inflammatory, immunosuppressive, antiallergic, anti-proliferative, anti-exudative and decreasing the microvascular permeability. By means of his primary effects, bethametasone has a significant secondary analgesic effect. The intramuscular administration of injectable suspension betamethasone sodium phosphate and betamethasone dipropionate induces an immediate therapeutic activity due to solubilized betamethasone sodium phosphate and a prolonged activity from slow release of betamethasone micro-crystals. The main indications for betamethasone are acute painful inflammatory disorders and acute exacerbations of chronic painful conditions. Betamethasone is administered intra-articularly by orthopedists and rheumatologists to treat osteoarthrosis and inflammatory arthritis. In patients with frequent intra-articular betamethasone application (> 3 times in a year) premature cartilage degradation, cortilago necrosis and in some cases a Charcote-like destructive arthropathy may develop as a consequence. In neurologic indication betamethasone is administered by intramuscular application in painful compressive radiculopathies due to herniated intervertebral disc, spinal stenosis, spondylarthrosis; decompensated osteoarthrosis; entrapment neuropathies; secondary myalgias, arthtralgias, muscle and tendon insertions disorders; focal myositis and secondary painful condition of varying and combined etiology. Betamethasone administered intramuscularly induces significant benefits in reducing pain and symptoms. The relief is most significant in the first week after betamethasone administration. Dosage and frequency of a possibly repeated administration of betamethasone depend on the condition severity and on the therapeutic response. Intramuscular injection of betamethasone has to be applicated deeply to the gluteal muscle under sterile conditions. Local side effects like hyper- or hypopigmentation, subcutaneous or cutaneous atrophy or sterile abscess are rare. Systemic complications are rare, too, transient hyperglycemia was observed in some diabetic patients.
Keywords: betamethasone phosphate, betamethasone dipropionate, mechanism of action, intramuscular administration, painful musculoskeletal disorders, safety profile, case reports
